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The Modern Metabolic Stone Evaluation in Children
Mark Bevill1, Ambika Kattula1, Christopher S Cooper1
1Department of Urology, University of Iowa, Iowa City, IA.
Insights
Pediatric kidney stones are increasingly common. Contemporary children with their first stone show fewer genetic causes but more low urine volume and hypocitraturia, indicating changing metabolic factors.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Pediatric nephrolithiasis incidence is rising.
- Etiologies of pediatric kidney stones may be evolving.
Purpose of the Study:
- Evaluate metabolic abnormalities in children after their first kidney stone.
- Identify changes in stone formation causes.
Main Methods:
- Retrospective review of 113 children (2000-2014) with first kidney stone.
- Comparison of demographics, serum chemistry, and 24-hour urine analysis.
Main Results:
- Low incidence of underlying genetic/systemic diseases (14%).
- Common 24-hour urine abnormalities: low urine volume (89%), hypocitraturia (68%).
- Hypercalciuria was rare (11%).
Conclusions:
- Modern pediatric stones have a lower rate of genetic/systemic disease and more idiopathic cases.
- Findings suggest a shift towards low urine volume and hypocitraturia as key metabolic factors.
- Contemporary pediatric stone disease exhibits different metabolic profiles than historical cohorts.
Objective:
To evaluate metabolic abnormalities in a contemporary pediatric population after their first stone episode. The incidence of pediatric nephrolithiasis is increasing and therefore the etiologies contributing to today's pediatric stone formation may also be changing.
Materials And Methods:
A retrospective review of all consecutive children presenting after their first kidney stone between 2000 and 2014 was performed. We compared demographic data, serum chemistry results, and 24-hour urine results and treatments.
Results:
One hundred thirteen children with a mean age of 11 years (5 months to 18 years) who presented with their first kidney stone episode between 2000 and 2014 were evaluated. Sixteen patients (14%) were found to have an underlying genetic or systemic disease. Overall, there was a low rate of serum chemistry abnormalities. The most common abnormalities found within the 24-hour urine evaluation included low urine volume (89%) and hypocitraturia (68%). Hypercalciuria occurred rarely (11%).
Conclusion:
We identified a low rate of underlying genetic or systemic diseases contributing to modern pediatric stone presentation and an increased proportion of idiopathic stones. Our study differs from historical findings by identifying a low rate of hypercalciuria and a high rate of low urine volume and hypocitraturia, suggestive of changing metabolic abnormalities contributing to modern pediatric stone disease.
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